title: Palliative sedation in patients with advanced cancer followed at home: a prospective study.
abstract: BACKGROUND
  Home care programs in Italy.
  
  
  OBJECTIVE
  The aim of this study was to assess a protocol for palliative sedation (PS) performed at home.
  
  
  METHODS
  A total of 219 patients were prospectively assessed to evaluate a PS protocol in patients with advanced cancer followed at home by two home care programs with different territorial facilities. The protocol was based on stepwise administration of midazolam.
  
  
  RESULTS
  A total of 176 of the patients died at home, and PS was performed in 24 of these patients (13.6%). Younger patients received the procedure more frequently than older patients (P=0.012). The principal reasons to start PS were agitated delirium (n=20) and dyspnea (n=4). Mean duration of PS was 42.2±30.4 hours, and the mean doses of midazolam were 23-58 mg/day. Both the home care team and the patients' relatives expressed optimal or good levels of satisfaction with the procedure in all but one case, respectively.
  
  
  CONCLUSIONS
  This protocol for PS was feasible and effective in minimizing distress for a subgroup of patients who died at home. The characteristics of patients who may be effectively sedated at home should be better explored in future studies.
authors.affiliation: Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Palermo, Italy; Palliative Medicine, Department of Anesthesia & Intensive Care, University of Palermo, Palermo, Italy. Electronic address: 03sebelle@gmail.com.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Mercadante
authors.affiliation: Home Care Program, L' Aquila per la vita, L'Aquila, Italy.
authors.forename: Giampiero
authors.initials: G
authors.lastname: Porzio
authors.affiliation: Home Care Program, Fondazione FARO, Torino, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Valle
authors.affiliation: Home Care Program, L' Aquila per la vita, L'Aquila, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Aielli
authors.affiliation: Department of Sciences for Health Promotion "G. D'Alessandro"-Hygiene Section, University of Palermo, Palermo, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Casuccio
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003693:Delirium / Q000188:drug therapy / Q000503:physiopathology; D004417:Dyspnea / Q000188:drug therapy / Q000503:physiopathology; D005190:Family / Q000523:psychology; D005240:Feasibility Studies; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007558:Italy; D008297:Male; D008874:Midazolam / Q000627:therapeutic use; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000503:physiopathology; D010166:Palliative Care / Q000379:methods* / Q000706:statistics & numerical data; D010348:Patient Care Team; D011446:Prospective Studies; D013727:Terminal Care / Q000379:methods* / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam
keywords: Palliative sedation; end of life; midazolam; palliative care